title: Maintenance chemotherapy for ovarian cancer.
abstract: BACKGROUND
  Epithelial ovarian cancer accounts for about 90% of all cases of ovarian cancer. Debulking surgery and six courses of platinum-based chemotherapy results in complete clinical remission (CCR) in up to 75% of cases. However, 75% of the responders will relapse within a median time of 18 to 28 months and only 20% to 40% of women will survive beyond five years. It has been suggested that maintenance chemotherapy could assist in prolonging remission. To date, there has not been a systematic review on the impact of maintenance chemotherapy for epithelial ovarian cancer.
  
  
  OBJECTIVE
  To assess the effectiveness and toxicity of maintenance chemotherapy for epithelial ovarian cancer and to evaluate the impact on quality of life (QoL).
  
  
  METHODS
  In the original review we searched the Cochrane Gynaecological Cancer Review Group Specialised Register, The Cochrane Central Register of Controlled Trails (CENTRAL, The Cochrane Library 2009, Issue 1), MEDLINE, EMBASE, PubMed, CBMdisc, CNKI and VIP (to May 2009). We collected information from ongoing trials, checked reference lists of published articles and consulted experts in the field. For this update, the searches were extended to October 2012.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing maintenance chemotherapy with no further intervention, maintenance radiotherapy or other maintenance therapy.
  
  
  METHODS
  Two review authors independently assessed trials for eligibility and quality and extracted data. We analysed overall survival (OS) and progression-free survival (PFS) rates as dichotomous variables. Toxicity and QoL data were extracted where present. All analyses were based on intention-to-treat (ITT) on the endpoint of survival. We also analysed data by subgroups of drugs.
  
  
  RESULTS
  We included eight trials (1644 women). When all chemotherapy regimens were combined, meta-analysis indicated no significant difference in three-, five- and 10-year OS or PFS. For five-year OS, the combined risk ratio (RR) was 1.03 (95% confidence interval (CI) 0.96 to 1.10) and for the five-year PFS, the combined RR was 1.06 (95% CI 0.97 to 1.17). Results were very similar when trials of different regimens were analysed. Comparing chemotherapy with radiotherapy, only the RR for 10-year PFS in pathological complete remission (PCR) was in favour of whole abdominal radiotherapy 0.51 (95% CI 0.27 to 1.00), while three- and five-year OS rates have no significant difference between the two groups.
  
  
  CONCLUSIONS
  There is no evidence to suggest that the use of platinum agents, doxorubicin or paclitaxel used as maintenance chemotherapy is more effective than observation alone. Further investigations regarding the effect of paclitaxel used as maintenance chemotherapy are required.
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, West China Women’s and Children’s Hospital,Chengdu, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Mei
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Dong Mei
authors.initials: DM
authors.lastname: Wei
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Guan J
authors.initials: GJ
authors.lastname: Liu
authors.forename: Huan Yu
authors.initials: HY
authors.lastname: Xie
authors.forename: Xun
authors.initials: X
authors.lastname: Wang
authors.forename: Juan
authors.initials: J
authors.lastname: Zou
authors.forename: Xu
authors.initials: X
authors.lastname: Han
authors.forename: Dan
authors.initials: D
authors.lastname: Feng
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D060046:Maintenance Chemotherapy / Q000009:adverse effects / Q000379:methods*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents